J Korean Orthop Assoc.  2019 Apr;54(2):133-140. 10.4055/jkoa.2019.54.2.133.

Value of Tibiotalocalcaneal Arthrodesis Using Retrograde Intramedullary Nailing in Severe Hindfoot Deformity and Arthritis

• Park JG
• Chung HJ
• Bae SY
• Lee JH
• Kim HY
• Lee JS

• KMID: 2444778
• DOI: http://doi.org/10.4055/jkoa.2019.54.2.133

Abstract

PURPOSE
This study examined the radiological and clinical outcomes of tibiotalocacalcaneal arthrodesis using retrograde intramedullary nailing in a severe hindfoot deformity and ankle/subtalar arthritis.
MATERIALS AND METHODS
A total of 22 patients (22 cases) with a severe hindfoot deformity and arthritis underwent tibiotalocalcaneal arthrodesis with retrograde intramedullary nails. The average age was 57.4 years (22-82 years) and the mean follow-up was 29.6 months (12-74 months). The radiological outcomes included an assessment of the preoperative and postoperative coronal ankle alignment, hindfoot alignment, sagittal alignment, and postoperative union time. The clinical outcomes were evaluated using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and postoperative complications. The results were analyzed statistically by dividing the patients into two groups based on a 10° angle of deformity.
RESULTS
Regarding the preoperative coronal ankle alignment, 14 patients had a mean varus deformity of 17.8°±14.5° and six had a mean valgus deformity of 8.1°±6.6°. Postoperatively, a satisfactory postoperative coronal ankle alignment of less than 5° was obtained in all patients. Regarding the preoperative hindfoot alignment, 12 patients showed a mean varus deformity of 15.2°±10.5° and six had a mean valgus deformity of 8.1°±4.2°. In total, 94.4% (17 patients) had satisfactory postoperative hindfoot alignment of less than 5°. Radiological union was achieved in 90.9% at an average of 19.2 weeks (12-32 weeks) and there were 2 cases of nonunion. The clinical outcomes showed improvement in the mean VAS and AOFAS scores (p<0.001, p<0.001, respectively). Even a preoperative severe deformity more than 10° showed a significant deformity correction of coronal ankle alignment and hindfoot alignment, postoperatively (p<0.001, p<0.001, respectively). No significant differences were found between the patients with a preoperative coronal ankle deformity more than 10° and those less than 10° regarding the mean postoperative coronal ankle alignment (p=0.162).
CONCLUSION
Tibiotalocalcaneal arthrodesis using retrograde intramedullary nailing is an acceptable technique for achieving satisfactory deformity correction, high union rate with minimal complications, and improvement of the clinical outcomes. In addition, tibiotalocalcaneal arthrodesis using retrograde intramedullary nailing is considered an effective treatment option, particularly in severe ankle and hindfoot deformities.

Keyword

deformity; arthritis; tibiotalocalcaneal arthrodesis; intramedullary nailing

MeSH Terms

Ankle
Arthritis*
Arthrodesis*
Congenital Abnormalities*
Follow-Up Studies
Foot
Fracture Fixation, Intramedullary*
Humans
Postoperative Complications

Figure

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  Figure 1 (A) Coronal ankle alignment is defined as the angle between the anatomical axis of the tibia and a line drawn perpendicular to the talar dome in a standing anteroposterior radiograph. (B) Hindfoot alignment is defined as the angle between the anatomical axis of the tibia and the longitudinal axis of the calcaneus in the hindfoot alignment view. (C) Sagittal alignment is defined as the angle between the anatomical axis of the tibia and a line connecting the inferior aspect of the posterior tubercle of the talus to the inferior talar neck in a standing lateral radiograph.

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  Figure 2 Both anteroposterior and lateral radiographs show the successful fusion trabeculae crossing the fusion site.

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  Figure 3 Standing radiographs and photograph of a 54-year-old female with equinocavovarus deformity demonstrates a correction of the deformity and osseous union after tibiotalocalcaneal arthrodesis with intramedullary nail.

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